Category Archives: health

Vaccination debates: the corona connection

The coronavirus pandemic has intriguing connections with longstanding debates about vaccination.

Background

Vaccination proponents say it’s one of the most important public health measures of the past century, with its benefits in reducing infectious disease vastly outweighing any small risks. Critics say the benefits are overrated and that adverse effects are greater than normally acknowledged.

This was the state of play before the emergence of the new coronavirus, officially known as SARS-CoV-2. How does the coronavirus disease, Covid-19, affect the longstanding claims and counterclaims in the vaccination debate?

 

Quandaries for vaccination proponents

Covid-19 undermines one of the usual arguments for vaccination, namely that unless most people receive routine vaccinations, there is a possibility of a pandemic like the Spanish flu of 1918–1920 linked to the deaths of tens of millions of people. A moment’s reflection, though, should be enough to realise that vaccinating against polio and measles provides little or no protection against a new virus.

Vaccination proponents have tacitly admitted that, when a vaccine is not available, other measures may be necessary, notably contact tracing, quarantine and physical distancing along with hand-washing and other hygienic measures to reduce the risk of transmission. These are relevant for many vaccine-preventable diseases such as measles and whooping cough but are seldom emphasised, perhaps because they might detract from the importance, efficacy and efficiency of vaccination as the first line of defence.

Covid-19 has brought another possibility onto the agenda: the immunity to an infectious disease acquired by having it. This sort of acquired immunity was common before the advent of vaccines.

The entire population, referred to as the herd, is protected if enough people are immune. When, before the measles vaccine, most children had measles, this provided protection for those whose immune systems were impaired. If most people in a community have had Covid-19 then, assuming having had the disease confers immunity, the pandemic will end. However, this is likely to involve much illness and many deaths before herd immunity is attained.

            Critics of vaccines have argued that there are advantages to acquiring immunity by having a disease. Before Covid-19, this argument received very little public attention.

In the vaccination debate, proponents emphasise the importance of herd immunity. This is taken to be vaccine-induced herd immunity. That is, when most people are vaccinated and most gain immunity as a result, the disease agent dies out for lack of individuals to infect.

Some commentators (including scientists) have suggested that widespread immunity acquired from having Covid-19 is an endpoint worth considering. A possible option is to allow or even encourage young and healthy people to be infected while protecting older vulnerable individuals. Few governments have adopted this option, perhaps because it clashes with the vaccination paradigm.

In summary, Covid-19 has undercut the common assumption that vaccines are the only way of dealing with infectious diseases. Claims about unvaccinated children being a health threat, and their parents being irresponsible, have been superseded by worries about contagion from coronavirus-infected individuals.

Quandaries for vaccine critics

For critics of vaccination, Covid-19 raises a possibility that might not be welcome: that an effective vaccine, if developed, might be just what is needed to bring the pandemic under control or to limit its damage. Although all vaccines pose risks, if Covid-19 is as deadly as commonly believed, even a vaccine with significant adverse effects could have more benefits than harms. This is the same sort of assessment used with other vaccine-preventable diseases.

There has been much commentary about how long it will take to test a vaccine and roll it out for the world’s population. There is no guarantee that an effective vaccine can be developed. Just as importantly, vaccines pose risks, especially when introduced for emergency purposes. Mention has been made of the vaccine for the 1976 swine flu, a vaccine that caused more harm than the flu.

Vaccine critics are already warning about the potential dangers of a coronavirus vaccine, especially one that has not received sufficient testing. Some critics see a coronavirus vaccine as a stalking horse for the introduction of mandatory vaccination, including for other vaccines. The social control measures introduced for dealing with Covid-19 might be a precursor for a different control measure: enforced vaccination despite the risks.

Absent viewpoints

The public debate over vaccination is polarised: there are two sides with sharply divergent positions on benefits, risks, ethics and decision-making. This polarisation of the public debate occurs despite both sides having the same ultimate goal: protecting the health of the population, especially children. One of the effects of polarisation is to sideline other perspectives.

Proponents and critics of vaccination agree that immunity to disease is important but differ about the sorts of immunity they emphasise. Proponents focus on the benefits of vaccine-induced immunity whereas critics point to the benefits of natural  immunity.

The immune system can also be boosted through various means, including exercise, diet, vitamin D, sleep and mindfulness. (For references, see my book Vaccination Panic in Australia, pages 352-355.) One of the contradictory features of the response to Covid-19 is that control measures, especially quarantine, distancing and closure of businesses, may have negative effects on an individual’s immune system.

When gyms and pools are closed and exercise classes banned, people get less exercise. In principle, people can exercise by themselves at home, and indeed are encouraged to, but for many individuals the control measures will reduce their level of physical activity. Exercise has many health benefits aside from immune system improvement.

            How control measures are affecting diet is hard to determine. Closure of fast-food outlets might improve some people’s diets. On the other hand, staying at home and worrying can lead to less healthy eating.

            The body manufactures vitamin D when the skin is exposed to sunlight. Staying inside reduces vitamin D production.

Ample sleep benefits people’s immune systems and general health. Staying home more of the time may be enabling people to get more sleep, though worries and physical inactivity can impair sleep quantity and quality.

Mindfulness refers to a state of mind that is calm and focused; meditation is one way to be mindful. Worrying about Covid-19, and obsessively seeking information about risks, is contrary to mindfulness. So are losing one’s job and worrying about finances.

Research shows that personal relationships are crucially important to happiness. Distancing measures have disrupted many relationships, especially physical contact, and thus have adversely impacted wellbeing. There are also other adverse impacts, including increases in domestic violence.

            It is difficult to quantify the impacts of control measures on exercise, diet, vitamin D, sleep, mindfulness and relationships and hence difficult to take them into account in policy-making. Probably the impacts are more negative than positive.

One thing is certain: the vaccination debate will continue. Covid-19 may be causing some shifts in public discussions about immunity and vaccination but is incapable of ending the overall controversy.

Brian Martin
bmartin@uow.edu.au

Thanks to Tonya Agostini, Kevin Dew, Meryl Dorey, John Potterat, Jennifer Reich, Samantha Vanderslott and Jody Watts for valuable feedback on drafts. None of them necessarily agrees with any of the views in this post.

Virus debates

The arrival in 2019 of a novel coronavirus and its potentially deadly disease Covid-19 has led to an outpouring of commentary. The impacts on daily life have been enormous, hence it is natural for people to try to understand the significance of these events from their own perspectives.

For several decades, I’ve been studying public scientific controversies, such as the ones about nuclear power, pesticides and fluoridation. There are some regular, often predictable, features of longstanding controversies. Usually there are two sides, with one side supported by most scientific experts and one side backed by groups with wealth and power. For example, in the pesticide debate, most scientists support the pesticide approach to dealing with pests, and this approach is backed by the companies that manufacture the pesticides. This is the most common configuration: scientific experts align with powerful groups. Two exceptions are the debates over smoking and climate change. In each one, most experts are on one side while the most powerful corporate groups with a stake in the issue are on the other side.


It’s debatable: do masks work?

            From the point of view of controversy studies, what is most interesting about Covid-19 is the proliferation of contentious issues in a wide range of domains. Here I can do no more than list a few of these, without commenting on how they might pan out. Because the issues are changing so rapidly, I’m not giving links to sources; it’s easy to find them with a few keywords.

* Seriousness. Commentators differ about how serious Covid-19 is and will be. If most people eventually are infected and the mortality rate is one percent, the ultimate worldwide death toll will be huge. On the other hand, some suggest that the number of infections has been underestimated, so the mortality rate is much lower than one percent, perhaps not much different than for seasonal flu. Judgements about the seriousness of Covid-19 influence views about a number of the other disputed issues, including control measures and civil liberties.

* Control measures. Some experts and citizens have called for stronger isolation measures, or for them to be rolled out sooner. Others raise concerns about the adverse effects of the measures, especially in hurting the economy.

* Civil liberties. Some governments have introduced new measures to track individuals, for example to see whether infected individuals are maintaining their isolation. Concern has been raised about the curtailing of civil liberties, and that the surveillance powers might be used for other purposes or to continue after Covid-19 dangers have waned.

            * Economic equality. Measures against Covid-19 have caused immense economic disruption, including severe hardship in some sectors, for example the tourism industry and spectator sports. Many people have lost their jobs, and businesses have gone bankrupt. This has led to calls for introduction of a universal basic income (UBI), namely a subsistence payment to every member of the population. With a UBI, most other welfare measures could be eliminated. Some governments have introduced measures to protect some hard-hit individuals or sectors of the economy, but so far have not moved to introduce a UBI.

            * Equity. The benefits of control measures are primarily to those who would be seriously ill or die from Covid-19. Those most vulnerable are mainly older people with pre-existing health conditions, whereas the costs of control measures fall on a broad swathe of the population. Simplistically, this is a case of the young making sacrifices for the benefit of the old and infirm. Some might contrast this with intergenerational equity in the climate debate, in which climate sceptics, who tend to be older and richer, do not want to make sacrifices for future generations.

* Treatment. The standard medical methods for treating Covid-19 include drugs, oxygen and, if necessary, ventilators and other life-support technology. Various alternatives have been touted. There have been reports that Chinese doctors have been using intravenous vitamin C in large doses. This is considered “alternative” and shunned or condemned by mainstream figures. Similarly controversial is the use of homeopathic remedies in India.

            * Environmental factors. The standard medical approach is to treat each patient as needed, to promote vaccination (when vaccines are available) and, especially in the case of the coronavirus, to institute physical-distancing measures to slow the spread of the virus. In alternative health circles, there has been attention to the role of environmental factors in making individuals more susceptible to infection. Two factors have received the most attention: 5G and air pollution.

* Vaccination. Having a vaccine is widely assumed to be a way to end the pandemic. There are disagreements about how soon a vaccine can be ready and about whether it is even possible. Critics raise concerns about the hazards of vaccines, especially ones prepared in urgency and insufficiently tested.

* Trust. Governments and health authorities say it’s important that their rules and recommendations be followed. In other words, they say “Trust us.” Some commentators deplore those who question the authorities and warn people against misinformation. Trust in authorities has been declining for decades, and in the US there is a very low level of trust in governments and pharmaceutical companies. Many individuals examine a range of information and make their own judgements. The issue of trust might be considered a meta-level disagreement or divergence, as it underlies many of the other areas of dispute.

The value of public discussion

Some commentators say that government and health authorities need to speak in one voice, because disagreement undermines the effectiveness of measures implemented. On the other hand, there are benefits from disagreement and debate. In a situation of uncertainty, it can be valuable to hear a range of viewpoints, even ones that might seem ridiculous on the surface. Many members of the public have time on their hands, are stuck at home, and have an intense interest in an issue that has disrupted their lives and sometimes their livelihoods, not to mention risks to health. They are bound to explore information on the web, and to use their own judgement about what to believe. In this context, it is valuable for contentious issues to be openly discussed and for views to be presented and challenged with evidence and logic.

            In many controversies, partisans tout evidence supporting their own position and attack weak points in the opponent’s position. This can rally supporters but is not convincing to opponents. A more rigorous approach is to spell out the strong points in the opponent’s position, ideally to the opponent’s satisfaction, and address them systematically. For example, it is easy to dismiss concerns that 5G is part of a plot to harm people but more rigorous to address arguments that 5G might have some impact, maybe small, on people’s immune systems. (I use this example because I haven’t examined any of the claims about 5G!)

Some people will be receptive to sensible comments. There should be no fear of dissent and debate, as long as participants engage with each other openly and respectfully.

Brian Martin
bmartin@uow.edu.au

Ageing: how to do it better

“If I had known I was going to live so long, I’d have taken better care of myself.”

There is an important truth in this saying. People in many countries are living longer than ever before. Surviving into your 80s, 90s and beyond is no longer unusual. However, quality of life in later years is not always the best due to dementia, disability, pain or loneliness. What can you do to ensure that your life is healthy for as long as possible?

            For the most comprehensive and up-to-date treatment available, turn to Daniel Levitin’s book Successful Aging, just published. Levitin is a neuroscientist who has written a number of books for general audiences. For Successful Aging, he said he examined more than 4000 scientific papers, many of which are listed in the back of the book. The main text, though, is free of academic apparatus. Levitin interviewed many individuals, including prominent ones like the Dalai Lama. His book is filled with anecdotes, quotes and stories as well as descriptions of research findings.

            Did you ever want to know how the brain operates? Consider your memory, something many older people worry about. Why does it seem to be getting worse? Levitin delves into the details of acquiring, storing and retrieving memories, telling about how there are different memory systems distributed across the brain. Did you know you can learn things better after exercising or that a chronic shortage of sleep can undermine acquisition of memories?

            Levitin tells about how many of the body’s systems degrade with age. Muscles become weaker, nerves respond less quickly and the mind is less receptive to new experiences. It sounds all downhill, but Levitin repeatedly emphasises the positives of being older.

As our senses acquire more experience, our minds become better at interpreting fuzzy sensations. The mind becomes more efficient at filling in incomplete perceptions, which means less effort and energy are required. So in some ways, perceptual capacities improve.

Older people, with their life experience in doing different things, have learned which ones give them satisfaction, and spend more time doing them. Older people, Levitin says, are less likely to dwell on negatives, instead focusing on positives. The result is that, according to surveys, people are happiest in the 80s, despite physical frailty and health problems. However, this is an average result: some oldies are unhappy while others flourish. Even so, for anyone younger, this is hope for the future.

Exercise and diet

Levitin emphasises several things that are especially important for ageing well. One of them is physical activity. Through various processes, it improves both physical and mental health. The biggest impacts come from modest amounts of activity when compared to none; successive increments of additional activity are beneficial but with declining marginal utility.

            Older people, at least those with aches and pains or with serious health conditions, may feel like they need to take it easy, but the evidence is that activity is beneficial to all. Levitin, giving special attention to mental functioning, recommends activity that requires mental alertness. He cites trekking on new paths, noting that the process of identifying the best spot to next put your foot stimulates the mind. Other options that do this include orienteering and competitive sports. On the other hand, using an exercise bike has more limited demands on the brain.

Another important contribution to healthy old age is an appropriate diet. Levitin canvasses a range of evidence about various options, for example the Mediterranean diet and the paleo diet. He concludes that the most important thing is to avoid processed foods and deep-fried foods. Aside from this, he says, it doesn’t seem to matter all that much what you eat.

Then there’s the question of how much to eat. Experiments with rats show that reducing the number of calories (or kilojoules) consumed leads to increases in longevity, but the evidence about this for humans is less than solid. Levitin notes that some researchers in this field have adopted occasional interruptions to normal eating patterns, skipping meals or fasting one day per week.

            Levitin is sceptical of the value of vitamin and mineral supplements, saying there is little evidence they significantly improve health. However, he is all in favour of vitamins and minerals ingested via a varied diet. More generally, he is sceptical of alternative medicine. He doesn’t mention that many in the alternative health area recommend fasting as a health practice.

Sleep and work

As a neuroscientist, Levitin gives plenty of attention to sleep because of its importance to functioning of the brain. Sleep enables consolidation of memories. It is also probably helpful in reducing the risk of dementia. Yet many people spend much of their lives in a sleep-deprived state. Levitin explains why. Prior to widespread artificial lighting, most people slept according to the cycle of day and night. Now, with electric lights, natural cycles are interrupted, and light from mobile devices extends the interruption.

            Most people use drugs to maintain alertness while awake — think coffee, tea, soft drinks and energy drinks — and sometimes to fall asleep. Levitin provides information on the down sides of this cycle, recommending a lifestyle that is closer to pre-industrial, for example avoiding blue lights (from screens) in the time before bed. There is also a cultural challenge: getting plenty of sleep is seen as an indulgence inappropriate for those trying to impress their colleagues about their commitment to work.

Re work, Levitin makes a strong recommendation: “Never retire.” He doesn’t mean to keep working at a job you hate. He means keep doing whatever provides challenge and a purpose in life. There’s no particular challenge in watching television or sitting beside the pool sipping a martini.

It is common to distinguish between work and leisure, and to see leisure as better. However, for quality of life, working at things you care about is important. Work provides a mental challenge. Also, interacting with people is good for the brain. Levitin recommends spending time with younger people, children and adults, as a way of maintaining mental openness to experience. Oldies have a harder time learning new things, so the pressure of interacting with youngsters is valuable in preventing getting stuck in mental routines.


Daniel Levitin

            What about doing puzzles such as sudoku and keeping mentally active through electronic brain training exercises? Levitin says these are fine but there’s no evidence that they prevent dementia. Doing sudoku helps you get better at sudoku but doesn’t seem to have any general benefit for mental functioning. That’s true of most activities: they help you do better at specific tasks. So for overall brain health, activities that stimulate the mind in varied and varying ways, including unpredictable ones, are the most beneficial.

People

Being lonely is bad for you: bad for you both physically and mentally. An important part of ageing well is maintaining social connections. This requires effort. As you get into your 70s and 80s and beyond, many of your long-time friends and contemporary family members are likely to die, so effort is required to build new personal connections, and this sort of effort tends to be greater for older people. For those with children and grandchildren, contact with a younger generation may be readily available, assuming they are nearby. Otherwise, though, it is important to try new activities, ones that are stimulating socially, mentally and physically.

Beyond individualism

Levitin’s advice is based on the latest scientific studies of ageing, nutrition, exercise, sleep and social interaction. His approach is most suited for affluent people. One thing is missing: social change. Levitin describes what you can do as an individual, assuming society is fixed. His recommendations could be turned around to become prescriptions for how society might be organised to support successful ageing.

Sleep, for example, has become more difficult because of the 24-hour economy and the proliferation of digital devices. Those who feel obliged to work the night shift pay a penalty in terms of their sleep and hence their health. Digital addictions, fostered by companies who profit from them, are also hindering sleep.

Similarly, societies organised around the car and labour-saving devices make it more difficult to get adequate exercise, and societies organised around the nuclear family make it more difficult to have everyday interactions with younger people.

It is fascinating to imagine a society organised to maximise brain rejuvenation. It would facilitate working at advanced ages, build physical activity into doing everyday things like shopping and commuting, and foster intergenerational interactions. The title of Levitin’s book, Successful Aging, might become Social Change for Ageing. Don’t expect this to happen quickly, or even in your lifetime. But promoting this sort of social change could provide a purpose in life, a purpose valuable for you and many others.

Brian Martin
bmartin@uow.edu.au

Postscript: a few quotes from Old age ain’t no place for sissies

“Age is a question of mind over matter. If you don’t mind, it doesn’t matter. – Satchel Paige

“Old age is like climbing a mountain. You climb from ledge to ledge. The higher you get, the more tired and breathless you become, but your views become more extensive.” – Ingrid Bergman

“Old age isn’t so bad when you consider the alternative.” – Maurice Chevalier

“The secret of staying young is to live honestly, eat slowly, and lie about your age.” – Lucille Ball

“Surely the consolation of old age is finding out how few things are worth worrying over” – Dorothy Dix

How old is old? Kids answer.

“I can’t imagine living past 45 or so. I think I’ll be so bored by then.” – Jenna, age 12

“No one is ever old until they’re dead.” – Leroy, age 11

The glyphosate chronicles

Glyphosate is the world’s most widely used herbicide. Is it as safe as its manufacturer claims?

Glyphosate is the principal ingredient in the herbicide named Roundup. It seems miraculous. It is deadly to weeds, yet harmless to humans, or so says Monsanto, the massive chemical company that manufactures it. (In 2018, Monsanto was purchased by Bayer.)

Glyphosate is used on crops such as soybeans, corn and canola. It is used by local governments to control weeds in public areas. It is used on golf courses. It is used by householders to maintain beautiful lawns.

The biggest use is on crops. Glyphosate is deadly to all growing things, so initially Roundup had to be applied to the weeds but not the crops. However, when the patent on Roundup was about to expire, Monsanto developed a brilliant way to maintain sales. Using genetic engineering techniques, it spliced a gene into crops, such as soybeans, that made them resistant to glyphosate. As a result, Roundup could be sprayed directly on the crops. Weeds would be killed, but genetically modified crops would not be harmed. Such crops are called Roundup Ready.

What happened when farmers started reporting disease and scientists started finding problems? If you want the inside story, get Carey Gillam’s book Whitewash: the story of a weed killer, cancer, and the corruption of science. Gillam is an experienced journalist who was put on the agriculture beat and began looking behind the scenes. The picture isn’t pretty. She is now research director at U.S. Right to Know.

The victims and the regulators

Monsanto claimed that Roundup was safe, so safe that you could probably drink it without harm. But what about farmers who had used Roundup for decades and then developed non-Hodgkin’s lymphoma? There seemed to be a pattern, especially given experiments with mice.

What about government regulators? The US Environmental Protection Authority (EPA) is supposed to be protecting the health of both people and the environment. Yet the EPA has seemed to be in the pocket of Monsanto, in all sorts of ways.

The EPA can set upper limits to the intake of chemicals. However, when it came to glyphosate, the limits it set were high, and were increased in line with increased use of the herbicide. This was despite the applications of glyphosate becoming ten times as great over a period of two decades.

You might expect that with glyphosate being the most heavily used herbicide in the world, there would be numerous studies of its prevalence and its impacts. Quite the contrary. For years, no figures were collected of the levels of glyphosate in different crops. The reason: because it was presumed to be safe, there was no need to see what levels were appearing in foods. For years, studies were not carried out on glyphosate’s possible health hazards. Again, the rationale was that it was so safe that there was no need for testing.

Much that Gillam reports relies on documents obtained using the discovery process in court cases, in which parties are required to provide relevant documents to the other side. Monsanto’s activities in subverting scientific research have been remarkable.

Monsanto cultivated allies within the EPA and used them to block introduction of regulations. It cultivated tame scientists who would go on the attack against anyone who criticised glyphosate. These tame scientists were given “talking points” so they would know what to say, and given guidance on venues for giving talks and submitting articles. These tame scientists did not reveal their links to Monsanto. In this way, Monsanto could get out its message via seemingly independent scientists.

Resistance – by pests

According to its promoters and defenders, glyphosate is a miracle chemical, so safe to humans that it can be used widely with little or no impact on human health. However, it is not pure glyphosate that is applied to crops, gardens and walkways, but Roundup, which contains additional chemicals, including one called polyethoxylated tallow amine or POEA. The combination of glyphosate and POEA is what needs to be tested, but this is hardly ever done.

However safe Roundup might be, there’s another problem. Pests can develop resistance to it. This is evolution in action: a few pest species have or acquire resistance to the pesticide, so they are the ones that start growing and spreading.

Because Roundup has been so remarkably effective in eliminating pests, farmers have become complacent. Instead of rotating crops – a traditional practice that reduces pest problems and replenishes the soil – farmers have planted the same crops year after year, relying on Roundup rather than other methods to keep pests at bay.

When Roundup-resistant pests started appearing, what was the solution? Farmers turned to other pesticides, using them in addition to Roundup. Some of these other pesticides are more highly toxic. This is the pesticide treadmill, in which the only solution to pests, even when they become resistant, is more pesticides.

Pesticide treadmill

Some farmers had nearly forgotten how to grow crops in traditional ways. Others, though, have turned towards alternatives, including organic agriculture.

History repeats

Is Gillam’s treatment of the glyphosate saga accurate? Her account rings true, because it is history repeating. Monsanto’s response to criticisms of Roundup is remarkably similar to the response by earlier pesticide manufacturers to criticisms.

Rachel Carson

Rachel Carson’s famous book Silent Spring, published in 1962, raised the alarm about the effect of pesticides on wildlife and, tentatively, on human health. Many people have heard of Silent Spring, which is often credited with inspiring the modern environmental movement. Less well known is that Carson and Silent Spring came under fierce attack by chemical corporations. This is documented in a revealing 1970 book by Frank Graham, Jr., titled Since Silent Spring.

In 1978, biologist Robert van den Bosch’s book The Pesticide Conspiracy appeared. Van den Bosch told about the strong-arm tactics of the pesticide manufacturers, recounting case after case of scientists whose research and careers were attacked after they reported findings critical of pesticides.

Gillam’s story of Monsanto’s tactics to attack any threat to its highly profitable Roundup is eerily similar to the tactics used by pesticide companies since the 1960s. It seems little has changed since, decades ago, I investigated suppression of scientists who questioned pesticides. Given that the tactics are predictable, it is plausible to work backwards and assume that presence of these tactics indicates the likelihood of shortcomings in the pesticide paradigm. So what are the tell-tale tactics?

* Attacks on scientists who report research results showing dangers or limitations of pesticides.

* Regulatory agency dependence on industry testing of pesticides.

* Testing only of the active ingredient, not of the pesticide actually used.

* Corporate ghostwriting of research papers.

* The failure of companies to release documents except through freedom-of-information requests or court discovery processes.

* A revolving door between company jobs and jobs in the corporate regulator.

* Presence on expert panels of members with conflicts of interest.

* Failure to carry out relevant research or collect relevant data, such as amounts and locations of pesticides used.

The presence of these tell-tale signs does not prove that a pesticide, or some other product or practice, is dangerous, but it does point to areas where extra scrutiny is warranted.

If you start investigating the likelihood that corporations and regulators are not serving the public interest, be prepared to be ignored or, if you start having an impact, being the target of dirty tactics.

Carey Gillam

“Monsanto Company and many leading chemical industry experts tell us that we should trust them and that more research is not needed. The safety of glyphosate and Roundup is proven, they say. But trust is hard to come by when the government does not require robust long-term safety data for a finished product such as Roundup, only for the active ingredient. There have long been concerns that the end product is more dangerous than glyphosate alone, and scientists say it is well-known that extra ingredients in pesticide products not only may themselves be toxic but also may enhance or supplement the toxic effects of the active ingredient. Extra ingredients in pesticides commonly include surfactants that help chemicals stick to the leaves of plants, antifoam compounds, and more. Yet the bulk of industry-sponsored toxicology tests are done using only the active ingredient. As well, there is very little long-term epidemiology data on glyphosate exposure, and there is no established base of information about just how much of the pesticide is in the products we eat and drink because the U.S. Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA) have so steadfastly avoided including glyphosate in their testing regimes. And despite industry assurances of safety, there is an international body of published research that contradicts those claims.” (pp. 79-80)

Brian Martin
bmartin@uow.edu.au

An HIV mystery in Africa

According to mainstream scientists, HIV transmission in Africa operates differently than elsewhere. An alternative view has been systematically ignored and silenced.


HIV prevalence in Africa

AIDS is the most deadly new disease in humans, with the estimated death toll exceeding 30 million. In order to restrain the spread of the infective agent HIV, scientists have tried to figure out how it spreads. The consensus is that HIV is most contagious via blood-to-blood exposures, such as through shared injecting needles, and in comparison the risks of transmission via heterosexual sex and childbirth are small.

However, there’s a mystery in relation to Africa. The scientific consensus is that in Africa, unlike elsewhere, HIV spreads mainly through heterosexual sex. Why should this be?

John Potterat is a public health researcher who spent decades tracking the spread sexually transmitted diseases in the US. He became interested in the African mystery and developed an alternative hypothesis. He and colleagues wrote many scientific papers about it, but were rebuffed by mainstream scientists. Here I will tell about Potterat’s experience drawing primarily on his engagingly written book Seeking the positives: a life spent on the cutting edge of public health, in particular the chapter “Why Africa? The puzzle of intense HIV transmission in heterosexuals”.

Some background

My own interest in research on AIDS derives from a different controversy, the one over the origin of AIDS. The standard view is that AIDS first appeared in Africa and was due to a chimpanzee virus, called a simian immunodeficiency virus or SIV, that got into a human, where it was called a human immunodeficiency virus or HIV. Chimps have quite a few SIVs, but these don’t hurt them presumably because they have been around long enough for the population to adapt to them, in the usual evolutionary manner. There are various species of chimps, and when a chimp is exposed to an unfamiliar SIV, it can develop AIDS-like symptoms.

            So the question is, how did a chimp SIV enter the human species and become transmissible? The orthodox view is that this occurred when a hunter was butchering a chimp and got chimp blood in a cut, or perhaps when a human was bitten by a chimp, or perhaps through rituals in which participants injected chimp blood.

In 1990, I began corresponding with an independent scholar named Louis Pascal who had written papers arguing that transmissible HIV could have entered humans through a polio vaccination campaign in what is present-day Congo, in which nearly a million people were given a live-virus polio vaccine that had been grown on monkey kidneys. The campaign’s time, 1957 to 1960, and location, central Africa, coincided with the earliest known HIV-positive blood samples and the earliest known AIDS cases.

            Despite the plausibility and importance of Pascal’s ideas, no journal would publish his articles, so I arranged for his major article to be published in a working-paper series at the University of Wollongong. Independently of this, the polio-vaccine theory became big news. Later, writer Edward Hooper carried out exhaustive investigations, collected much new evidence and wrote a mammoth book, The River, that put the theory on the scientific agenda. Over the years, I wrote quite a few articles about the theory, not to endorse it but to argue that it deserved attention and that scientific and medical researchers were treating it unfairly.

In the course of this lengthy controversy — which is not over — I became increasingly familiar with the techniques used by mainstream scientists to discredit a rival, unwelcome alternative view. I had been studying this, on and off, since the early 1980s; the origin-of-AIDS saga made me even more attuned to how dissenting ideas and researchers can be discredited.

With this background, when I read John Potterat’s chapter “Why Africa?” it was like he was providing a front-row seat for a tutorial on how an unwelcome view can be marginalised. I saw one familiar technique after another.

I’m not here to say that Potterat’s view is correct. Furthermore, unlike the origin-of-AIDS debate, I haven’t studied writings about HIV transmission in Africa. What I do here is outline Potterat’s account of his experiences and comment on the techniques used to dismiss or discredit the ideas he and his collaborators presented to the scientific community.


John Potterat

Contact tracing

HIV is infectious, so it is important to know exactly how it gets from one person to another. Knowing transmission routes is the basis for developing policies and advice to prevent the spread of the virus.

In Seeking the Positives, Potterat tells about his personal journey in scientific work. It was unusual. With a degree in medieval history, he ended up with a job in Colorado Springs (a moderate-sized town in Colorado) tracking down networks of people with sexually transmitted diseases (STDs). Learning from his mentors, the approach he developed and pursued with vigour was to interview infected individuals, find out their sexual or injecting-drug partners and proceed to build up a database revealing the interactions that spread the disease. The military base near the city meant there were lots of prostitutes (some permanent, some seasonal) and STDs to track. This sort of shoe-leather investigation (seeking those positive for disease) led to many insights reflected in a vigorous publication programme. For the Colorado Springs research team, AIDS became a key focus from the 1980s on.

When submitting a paper to a scientific journal, editors and reviewers are supposed to assess it on its merits. It should not matter whether an author has a PhD in epidemiology from Oxford or no degree at all. The test is the quality of the paper. Potterat became the author of dozens of scientific papers. However, his unusual background may have been held against him in certain circles.

In Seeking the Positives, Potterat doesn’t tell that much about his team’s clients/informants. Sensitively interviewing prostitutes, partners of prostitutes, drug users, gay men and others would have been a fascinating topic in itself, but Potterat focuses on the research side of the story.


A diagram from one of Potterat’s papers

            You might think that contact tracing is an obvious way to study the transmission of disease, especially a new disease for which the patterns of contagion are not fully understood. But what Potterat’s team was doing was unusual: mainstream AIDS researchers pursued other approaches. Because the mainstream researchers had lots of research money, they didn’t take kindly to a small, non-prestigious team doing something different.

Mainstream groups, both researchers and activists, raised a series of objections to HIV contact tracing. First they said there was no reason for contact tracing unless there was a test for HIV. Second, after a test became available in 1985, they said tracing would allow the government to compile lists of homosexuals. Third, they said that without effective treatment, notifying individuals would distress them and lead to suicides. Fourth, after the drug AZT became available in 1987, they said contact tracing would be too expensive.

            The interesting thing here is that none of the objections was backed by any evidence. Potterat says that in his team’s studies nearly all of those approached for contact tracing were very helpful.

“Contact tracing was generally opposed by AIDS activists, by civil libertarians, and (disappointingly) by many public health workers, who were often influenced by political correctness and by not wanting to offend strident constituencies.” (pp. 68-69)

Later, mainstream public health officials in the US took the line that AIDS was a danger to the heterosexual population, not just to gays and injecting drug users. If HIV was highly contagious in the wider population, this lowered the stigma attached to gays and injecting drug users, and coincidentally made it possible to attract more funding to counter the disease, a worthy objective. However, contact tracing showed that HIV transmission was far higher in specific populations. This was another reason the research by Potterat’s group, published in mainstream journals, didn’t lead to changes in research priorities more generally.

HIV transmission in Africa

In 2000, Potterat was approached by David Gisselquist about the spread of AIDS in Africa, questioning the usual explanations for why the mechanisms were claimed to be different from those in Western countries. After his retirement the following year, Potterat and some of his collaborators joined with Gisselquist in examining the studies that had been made.


David Gisselquist

            The orthodox view was that in Africa, uniquely, HIV transmission occurs primarily through heterosexual sexual activity. This, according to Potterat et al., was based on assumptions about high frequencies of sexual interactions and high numbers of partners, neither of which were supported by evidence. They said the evidence suggested that sexual activity in Africa was much like elsewhere in the world.

In this was the case, the orthodox view couldn’t explain HIV transmission in Africa, so what could? The answer, according to Potterat and his collaborators, was skin-puncture transmission that occurred when contaminated needles were reused during health-care interventions such as blood testing, vaccinations and dental work, plus tattooing and traditional medical practices. This was heresy. It was also important for public health. Potterat writes, “Only when people have accurate knowledge of HIV modes of transmission can they make good decisions to protect themselves and their families from inadvertent infection.” (p. 200)

Potterat’s team wrote dozens of papers, but they had a hard time getting them published in top journals, where orthodoxy had its strongest grip. Nevertheless, they were quite successful in publishing in reputable journals of slightly lower standing.

Responses

The most common response was to ignore their work. Even though Potterat et al. had poked large holes in the orthodox view, orthodoxy was safe if the critique was given no attention.

Another response was to try to prevent publication of orthodoxy-challenging research. One study was by a team, not Potterat’s, involving Janet St. Lawrence, then at the Centers for Disease Control and Prevention (CDC), and her colleagues. According to Potterat, St. Lawrence’s CDC superiors asked her not to publish the paper, but she refused. The paper was rejected by several journals, and then submitted to the International Journal of STD & AIDS. After peer review and acceptance, the CDC applied pressure on the editor to withdraw acceptance, but he refused. This is just one example of efforts made to block publication of dissenting research findings.


Janet St. Lawrence

“… it does not engender trust in the official view to know that our informal group has solid evidence of several instances by international health agencies actively working to suppress findings supportive of non-sexual transmission and to discourage research into non-sexual transmission.” (p. 221)

Another tactic was to misrepresent views. On 14 March 2003, the World Health Organisation held a meeting of experts to, as stated in a memo to participants, “bring together the leading epidemiological and modeling experts with Gisselquist and Potterat.” Potterat was dismayed by the consultation: data disagreeing with the orthodox view was dismissed. After the meeting, a statement was put out by WHO presented as representing a consensus. Actually, this so-called consensus statement did not represent everyone’s viewpoints, and was actually finalised prior to the conclusion of the meeting. (This was an exact parallel to what happened at an origin-of-AIDS conference.)

Potterat was surprised and disappointed to be subject to ad hominem comments, otherwise known as verbal abuse. He writes:

“Among other, less printable, things I was called ‘Africa’s Newest Plague’; ‘Core Stigmatizer’; ‘Linus Pauling—in his later years’ (when Pauling was thought to be advancing crackpot ideas); and [a reward being offered] ‘for his head on a platter’.” (pp. 193-194)

Potterat was surprised at this invective because none of his team had imagined the resistance and anger their work would trigger among mainstream agencies and researchers. He was disappointed because many of the comments came from colleagues he had previously admired.

Undone science

Researchers into the dynamics of science have coined the term “undone science” to refer to research that could be done and that people are asking to be done, but nevertheless is not carried out. A common reason is that the findings might turn out to be unwelcome to powerful groups. Governments and industry, through their control over most research funding, can stifle a potential challenge to orthodoxy by refusing to do or fund relevant research.

            Undone science is most common in areas where citizen groups are calling out for investigations, for example on the environmental effects of mining in a particular area or the health effects of a new chemical. Three research students who I supervised used the idea of undone science as a key framework for their theses, on drugs for macular degeneration, on vaccination policy, and on the cause of the cancer afflicting Tasmanian devils. My former PhD student Jody Warren and I, drawing on our previous work, wrote a paper pointing to undone science in relation to three new diseases. With this experience, I was attuned to notice cases of undone science in whatever I read. In Potterat’s chapter “Why Africa?” there were many striking examples.

In their papers, Potterat and his colleagues presented findings but, as is usual in scientific papers, acknowledged shortcomings. In one case, to counter criticisms, they reviewed research on the efficiency of HIV transmission by skin-puncturing routes, while admitting that new studies were needed to obtain better data. Potterat concludes, “To my knowledge, such studies have not been fielded.” (p. 199)

In another study, on discrepancies in studies of Hepatitis-C strains and patterns, Potterat writes, “In the intervening decade, however, no studies had been fielded to resolve these uncertainties.” (p. 199)

Potterat and his collaborators were unable to obtain external funding to carry out studies to test their hypotheses. So Potterat used his own money for a small study of HIV transmission in Africa. “Yet this pilot study supported our contentions and should have provoked the conducting of larger studies to confirm our findings. Regrettably, this did not happen.” (p. 205)

Similar responses

As stated earlier, I am not in a position to judge research about transmission of HIV in Africa. I approach the issue through Potterat’s account of the tactics used by supporters of orthodoxy against a contrary perspective. The tactics, according to him, included ignoring contrary findings, denigrating the researchers who presented them, putting out a misleading consensus statement, and refusing to fund research to investigate apparent discrepancies. I was struck by the remarkable similarity of these tactics to those used against other challenges to scientific and public-health orthodoxy. This does not prove that the dissident viewpoint is correct but is strong evidence that it has not been treated fairly. To be treated fairly is usually all that dissident scientists ask for. The hostile treatment and failure to undertake research (“undone science”) suggest that defenders of orthodoxy are, at some level, afraid the challengers might be right.

Potterat nicely summarises the multiple reasons why the findings by him and his colleagues were resisted.

“By their own admission, the international agencies feared that our work would cause Africans to lose trust in modern health care, especially childhood immunizations, as well as undermine safer sex initiatives. (Recall that their condom campaigns were also aimed at curtailing rapid population growth in sub-Saharan Africa.) We speculate that disbelief on the part of HIV researchers that medical care in Africa could be harming patients may have been a significant factor in their defensive posture. We were also impugning the quality of their scientific research and potentially threatening their livelihoods. In addition, our analyses also directly threatened the politically correct view that AIDS was not just a disease of gay men and injecting drug users, but also of heterosexuals. Lastly, our data were undermining the time-honored belief about African promiscuity, a notion that may well have initially contributed to the (pre)conception that AIDS was thriving in Africa because of it.” (p. 194)

The depressing lesson from this saga, and from the many others like it, is that science can be subject to the same sorts of groupthink, intolerance of dissent, and defence of privilege that afflict other domains such as politics. To get to the bottom of long-standing scientific disputes by trying to understand the research is bound to be time-consuming and very difficult, something few people have the time or interest to pursue. I aim at something easier: observation of the tactics used in the dispute. This doesn’t enable me to determine which side is right but does give a strong indication of whether the dispute is being pursued fairly.

Brian Martin
bmartin@uow.edu.au

Thanks to Al Klovdahl for valuable suggestions.

Obtain free downloads of John Potterat’s chapter “Why Africa?” or the entire book Seeking the Positives

Addicted to the screen?

Behavioural addictions are on the rise. It’s important to understand and be able to change them.

It’s commonplace to see people walking along with their eyes focused on their smartphones. Surveys show that many check their phones the last thing before going to sleep and the first thing when they wake up. And they have them within arm’s reach the whole night.

Some online gamers refuse to take a break, playing for days and nights on end. Playing the game becomes more important than eating or sleeping.

Is it reasonable to refer to obsessions of this sort as addictions? If so, they are addictions to behaviours, not substances.

            For insight into this rising problem, check out Adam Alter’s new book Irresistible. The subtitle explains the topic: Why we can’t stop checking, scrolling, clicking and watching. The book is highly readable, though not quite as irresistible as the activities Alter describes.

            To provide a context for understanding behavioural addictions, Alter examines the more familiar sort of addiction, to drugs. The usual idea is that the physical processes involved are the key, including wanting the drug and having withdrawal symptoms. In relation to pain medication, Alter says something more is involved: a psychological component, in particular emotional pain. Alter says addiction “isn’t the body falling in unrequited love with a dangerous drug, but rather the mind learning to associate any substance or behavior with relief from psychological pain.” (p. 89) For example, people who were sexually abused as children may cover up the emotional pain by using drugs.

So what’s involved?

“Behavioral addiction consists of six ingredients: compelling goals that are just beyond reach; irresistible and unpredictable positive feedback; a sense of incremental progress and improvement; tasks that become slowly more difficult over time; unresolved tensions that demand resolution; and strong social connections.” (p. 9)

Alter devotes a chapter to each of these six ingredients. One of the fascinating insights is the way designers try to make activities enticing.

Consider poker machines, in which players put in their money in the hope of winning a prize, especially a jackpot. Research shows that near misses provide an incentive to keep playing. Even so, there are fallow periods with no wins during which players are inclined to quit. In the US, gambling establishments are prohibited from manipulating the odds. So instead of the machine giving a little payout just when a player was thinking of quitting, an employee, watching the proceedings, will provide a small gift, such as chocolates. Even this process can be automated, with the machine providing information to the proprietors as to when to offer a gift to a player.

            Gambling addictions involve unpredictable positive feedback, but there is not incremental progress and improvement. For greater behavioural addiction, skill is involved, and skills improve.

Video games are the most common type of behavioural addiction. The most engaging games are very easy to learn, provide pathways for gradual improvement but make it impossible to achieve total mastery: there is always another level of difficulty. Alter interviewed video game designers. Some of them became addicted to their own games, and so did everyone else around them.

            Television producers try to induce viewers to keep watching a serial by using the technique of “unresolved tensions that demand resolution”, more commonly called cliffhangers. Near the end of an episode, some new development – an unexpected phone call, illness or assault – will be provided so viewers will want to tune in to the following episode to find out what happened next, namely to resolve the tension. This technique helps explain the popularity of soap operas and quite a few TV series. However, watching a show once a week is not a big problem. The addictive qualities of cliffhangers become more obvious when entire series are available on demand. Some viewers watch two or more episodes at once, or even binge for several days.

Knowing about the cliffhanger technique, a bit of planning can overcome bingeing on multiple episodes. The key is to end the viewing session after resolution of the tension, maybe 5 or 10 minutes into the next episode, and then start there the next time.

Alter provides numerous tips for overcoming or avoiding addictive behaviours. Email is a common problem: as soon as there’s a notification of an incoming message, it has to be checked or willpower is needed to resist checking it. One solution is to disable notifications. An even stronger technique is to shut down email altogether for most of the day, only opening it for a limited time. Alter counsels against the aspiration of an empty inbox, because this goal encourages obsessive checking of emails.

It’s now possible to buy all sorts of monitors, for example to record your pulse and the number of steps you’ve taken. Setting goals is fine, but Alter warns about making them too precise. When setting yourself the goal of 12,000 steps in a day, there’s a risk of injury by over-exercising. The target goal can overshadow messages from the body about exhaustion or pain. Self-monitoring runs the risk of encouraging addiction.

Who is susceptible?

It used to be thought that drug addicts had weak personalities and that to break an addiction, all that is needed is the assertion of willpower. These views are thrown into question by evidence that the environment makes a huge difference in addictions. Alter refers to the heroin users among US troops in Vietnam during the war. On returning to their home communities in the US, very few maintained their habits. The implication is that changing an addict’s environment is central to change. This includes being around different people and avoiding the triggers for the habit.

With behavioural addictions, environments are changing in ways that make more people susceptible. Video game addiction occurred from the earliest days of gaming. It was often thought that young males were especially vulnerable. But the reason they were more commonly addicted was opportunity. Not having jobs or other responsibilities, and having access to game consoles, they could devote hours to gaming every day.

            Therapists who treat gaming addicts have noticed an explosion in addiction in the US since the arrival of the iPhone in 2007 and the iPad in 2010. Suddenly many more women and older men began developing addictions. The reason: access to games has gone mobile. No longer anchored to a console, you carry your device with you. It’s like having drugs on demand, with no cost.

For substance addictions, one treatment option is abstinence. It’s possible to totally avoid alcohol or heroin, and this is the basis of twelve-step programmes, most famously Alcoholics Anonymous. However, treating Internet addictions through abstinence is not feasible, because jobs and other activities so commonly involve operating online. Alter canvasses various ways to deal with Internet addiction. Many of these draw on insights about how to change habits.

The difficulty of changing habits points to a strange discrepancy. Powerful groups seek to promote behaviours, like checking Facebook, that serve their interests, but that can become addictive. There are relatively few groups dedicated to countering these potentially addictive behaviours. Furthermore, there is even less effort put into helping people break damaging habits.

It’s worth thinking broadly about damaging habits and challenges to them. Smoking is the classic example. Tobacco companies benefited from hooking people on smoking and it has taken extraordinary efforts by campaigners to bring tobacco addictions under control. A key part of the change has been to make ever more spaces non-smoking. Another part has been to stigmatise smoking.

Alcoholism remains a scourge on many people’s lives. Alcohol producers so far seem to have avoided many of the controls applied to smoking.

Then there are illegal drugs such as marijuana, heroin and ice. The prohibitionist impulse is a manifest failure, enabling the rise of organised crime with disastrous consequences for users and their families.

With the vast expansion of behavioural addictions, what are the choices? Internet companies benefit from behaviours, like checking phones regularly, that easily become addictive. Because there is relatively little harm to others, there is unlikely to be a movement analogous to the anti-smoking movement. So what are the prospects?

            One source of hope is the availability of apps and devices to control Internet use, for example apps to shut down access after a specified time. But even to use such apps requires a degree of self-awareness. Ultimately, the culture of Internet use needs to change. If checking a phone while talking face-to-face with a friend were seen as extremely discourteous, there is some hope, but only if talking face-to-face remains common. Perhaps things will have to become much worse before major efforts are made to change social expectations.

Imagine that all children learn, at home and in school, the characteristics of addictive behaviour and how to change habits. Imagine people becoming more self-aware of their own damaging or time-wasting habits. Imagine companies becoming more responsible. If you’ve come this far, you have a good imagination and maybe you’re just dreaming.


Adam Alter

Brian Martin
bmartin@uow.edu.au

Vaccination in perspective

To understand debates over vaccination, it’s valuable to look at the history and politics of vaccine development and policy-making.

Australian government health departments and leaders of the medical profession are united in supporting the standard programme of childhood vaccines. Vaccination rates in Australia are high and stable. However, a small number of citizen vaccination sceptics continue to raise concerns.

In the 1990s, Meryl Dorey set up what became the Australian Vaccination Network (AVN), around the same time as vaccine-critical groups were formed in several other countries. Then, in 2009, some citizen vaccination proponents set up Stop the Australian Vaccination Network (SAVN), dedicated to discrediting, silencing and destroying the AVN. There has been a ferocious struggle between SAVN and the AVN. SAVN’s campaign was instrumental in politicians bringing in measures to pressure parents to have their children vaccinated, even though some pro-vaccination researchers opposed the measures.

            SAVN is strident in its advocacy, with the mantra “Vaccination saves lives.” AVN members, and quite a few others, remain sceptical. They continue to question the effectiveness of vaccination, raise the alarm about adverse reactions, and suggest vaccination may be implicated in diseases such as autism.

Both sides adopt the mantle of science, claiming the evidence supports their viewpoints. SAVN denigrates vaccine sceptics as deluded or ignorant. Some vaccine critics say proponents are in the thrall of the pharmaceutical companies.

In this highly polarised debate, there is little room for anyone to take an intermediate position, for example saying that many vaccines are worthwhile but others are unnecessary. However, this might well be the view of some parents, though they are given little support to express their views. Any reluctance about vaccination can lead to the stigma of being called an “anti-vaxxer.”

Immunization: How Vaccines Became Controversial

Stuart Blume is emeritus professor of Science and Technology Studies at the University of Amsterdam. He has a lifetime of experience researching the politics of science and technology, and two decades ago began studying the vaccination issue. His approach can be called social history: a study of history taking into account social and political dynamics. Blume brings to the issue the perspectives of science and technology studies, seeing science and technology as subject to social processes.

            Blume decided to write a book summarising insights from his research. The result is Immunization: How Vaccines Became Controversial, recently published. I wrote one of the endorsements on the book jacket.

There is much here to ponder. The book does not mesh neatly with either the pro or anti positions in the usual public debate.

Blume tells two sorts of stories, one about vaccines and one about vaccination policy, and neither is a just-so story. Many traditional histories present science as a continual upward trajectory of discoveries and the overcoming of misguided beliefs. Blume, though, follows the path of historians of science who report on uncertainties, mistakes and unproductive paths. The implication is that present knowledge may be just as precarious, in its own way, as past knowledge.

Knowledge about vaccines and the immune system developed gradually, and for many decades there was no assumption that vaccination would prove to be a major route to public health. Smallpox was the initial target for vaccination, but there were many other killer diseases, such as diphtheria and tuberculosis, and other ways to address them besides vaccination. Today, with the focus on vaccination, it is sometimes forgotten that infectious disease can also be addressed through quarantine, sanitation, improved diet and general increases in the standard of living.

Vaccination campaigns are not always the best strategy to improve health. Blume highlights a problem with the polio eradication campaign. In a number of poor countries, resources for public health interventions were siphoned off to support polio eradication, which meant that impoverished people, needing basic medicines, were instead offered polio vaccinations, something less important for their own health.

A related tension permeated vaccination development beginning in the 1980s, when commercial considerations became paramount. Effort was put into developing vaccines for problems in affluent countries, where money could be made, while major illnesses in impoverished populations were left unaddressed.


Stuart Blume

            Blume notes that vaccination is often treated in isolation, as a special method of promoting public health, and not compared with other methods. To counter this tendency, he presents vaccination as a technology, in the broad sense of a set of techniques and artefacts, that can be compared to other public health technologies such as sanitation. He sees vaccination as a socio-technical issue, as having both scientific and policy dimensions, and as shaped by social, economic and political influences in both these dimensions.

Blume addresses vaccines separately, rather than as a group. As a result, he does not make a universal judgement about vaccination, as a good or bad thing. In these ways, Blume offers a different perspective than the one taken by most of the campaigners for or against vaccination.

One of the peculiarities of the vaccination debate is that nearly all the disagreement is about whether vaccination is beneficial or harmful, for example whether it has led to declines in infectious disease or whether there are significant numbers of adverse effects. Seldom are comparisons made with other ways of improving health, in particular children’s health, for example addressing poverty. Blume notes some of the disagreements about early vaccines.

As many infectious-disease killers were brought under control in western countries, while others such as HIV were proving too difficult, vaccine developers turned to other diseases, seeing opportunities for profits. Blume writes that the rise of neoliberalism led to significant shifts in the rationale for new vaccines. Whereas previously companies and scientists had freely shared information and vaccines in a common commitment to public health, from the 1980s onwards the pharmaceutical industry became more dominant and less public spirited.

Government health departments in different countries responded to industry pressure in different ways. It became more common to use cost-benefit analysis, especially given that many new vaccines were highly expensive. Health departments sometimes approved new vaccines without as much evidence as they might have required earlier.

            Cost-benefit analysis is not a good way to promote vaccines to the public. In several cases, notably measles and mumps, companies adopted a “rebranding” strategy to convince parents that diseases they had known as a routine and unthreatening part of childhood were actually killers to be feared and thus protected against using vaccines.

Blume believes that vaccines have saved millions of lives. Yet he is also sceptical of many of the latest vaccines, developed not as part of a public health agenda but by pharmaceutical companies whose primary aim is profit. Furthermore, there are dozens of new vaccines under development, many of them targeted at non-infectious diseases such as breast cancer.

Vaccination seems to have become a single-method solution for health problems, overshadowing primary health care that addresses the conditions that cause disease in the first place. Think how much easier it is to sell a vaccine than to address poverty and inequality, or illnesses due to industrial chemicals.

Vaccine hesitancy

For many readers, the most interesting part of Blume’s book will be the final chapter in which he addresses current anxieties about vaccination, especially in the west. He dismisses the idea, common among vaccination promoters, that the source of the anxieties is vaccine-critical groups such as the AVN. Sociologically, this explains neither the existence of the groups nor their alleged influence. It is like saying the reason people are concerned about economic inequality is because of protesters.

Blume cites research into the attitudes of parents that suggests something deeper is at play. Rather than dividing people into vaccine-acceptors and vaccine-refusers, Blume addresses a widespread vaccine hesitancy that affects many parents, especially well-educated ones, even when they adopt all the standard vaccinations.

Rather than vaccine-critical groups being the cause of vaccine hesitancy, it is better to understand them as a result of changed perceptions. Blume says vaccination has, for many people, become symbolic of a more general unease and sceptical attitude about the role of pharmaceutical companies and the medical profession. He notes that the usual survey research carried out by vaccination proponents can pick up demographic variations in parental concerns but does not get to their source.

It is perhaps relevant that citizens have no say in the development of vaccination recommendations, and even politicians are usually left out of the picture, as decisions are made by international organisations subject to corporate lobbying. This does not mesh well with people’s increasing knowledge about health matters. The experts might be right but nonetheless be distrusted.

Immunization: How Vaccines Became Controversial provides great insight precisely because it eschews the easy generalisations made by vaccination partisans. Vaccine development was not a straightforward linear process, and vaccination policy has been subject to a variety of influences. Vaccination is usefully seen as a technology, as just one of several approaches to promoting health, and thus judged in a wider context than a narrow calculation of benefits and risks. The contemporary vaccination debate is not just a matter of pro and anti, but should be seen in the wider context of attitudes towards social institutions and citizen participation in decision-making.

Blume does not offer easy answers, but more usefully points to the complexities and contradictions in the history and social dynamics of vaccination. It is essential reading for anyone who wants to get beyond the usual partisan positions in the vaccination debate.

Brian Martin
bmartin@uow.edu.au

Opiate addiction in a market economy

In the US, there has been a huge increase in deaths from heroin overdoses. Why?

In the past two decades, opiate use in the US has soared, and so have deaths from overdoses. The amazing story explaining why is told by journalist Sam Quinones in his 2015 book Dreamland: the true tale of America’s opiate epidemic. Quinones spent years interviewing users, parents of users, drug dealers, researchers, police and others. Dreamland is fascinating reading, telling the stories of individuals and communities caught up in the opiate epidemic.

There are two parallel stories involved, involving legal and illegal drug use. The legal side concerns painkillers. US doctors have long used morphine as a painkiller, but only as last resort because of the risk of addiction. Then came the “pain revolution,” during which opiates became acceptable and often prescribed in ever-increasing amounts.

The change in attitude was driven by commercial considerations. The company Purdue Pharma developed a time-release opiate pill, gained government approval for its sale and embarked on a massive marketing campaign to win over doctors. A key part of the sales pitch was that because there was no euphoria from an immediate hit, the drug was hardly ever addictive. To back this claim, Purdue representatives referred to an obscure publication.

Quinones found that doctors went along with these claims, with no one bothering to look at the publication. Its authors had forgotten about it and didn’t know it was being used to justify massive opiate prescribing. (Like Quinones, I’m not distinguishing between opiates and opioids.) As it turned out, the claims about there being little addictive capacity were wrong.

The marketing pitch was that if someone has pain, prescribe Vicodin or OxyContin, and if the pain continues, up the dose. Before long, huge swathes of the population were seeking prescriptions. Some unscrupulous doctors set up pill dispensaries, writing scripts for anyone who asked. Users would get their prescriptions filled at a low price subsidised by the government and sell portions to others to maintain their habit. At these dispensaries, lengthy queues would form of people waiting for their drugs.

The areas of the country most affected were those where the economy was in decline, so many residents faced bleak times. Quinones tells about small and mid-sized towns in Ohio and neighbouring states, subject to deindustrialisation and despondency about civic pride and public life. Addiction took hold, but it took a while before authorities realised the scale of the problem. One reason was that the parents of those most affected were ashamed to admit their son or daughter was an addict. They were white middle class.

The Mexican connection

In the small Mexican state of Nayarit, poppy seeds grow abundantly. Boiled down, they form a sticky substance called black tar. It is heroin. Some entrepreneurs from Nayarit came to the US and began building a heroin franchise operation. It was like nothing before.

Previously, most heroin imported to the US came from Asia, especially Afghanistan, brought in through New York and distributed by gangs. This heroin was often cut, namely adulterated, as it moved down through the distribution chain. Many small-time dealers were themselves addicts; dealing is a way of making money to support a habit. The heroin business is highly profitable, leading to violence between operators and drawing the attention of the police. It is devastating to poor inner-city areas, especially black neighbourhoods.

The Nayarit entrepreneurs developed a different model. They brought in poor young men from Xalisco, a small city in Nayarit, who were willing to work at low pay in the US because the alternative was backbreaking work on sugar fields at even lower pay. These young men were paid a wage, so they had no incentive to adulterate the heroin they delivered. Furthermore, they were not users themselves. They lived in barren apartments and were given old cars to make deliveries. After a few months they were sent back to Mexico.

            The Nayarit entrepreneurs had several rules. They did not use violence and did not carry guns. They sold only to whites, as this was considered far safer. And they marketed only in areas where the previously established heroin operations were absent, such as Portsmouth, Ohio.

The Nayarit operators used a pizza-delivery model. They prepared black tar in carefully measured amounts tied up in balloons. They would hand out a mobile phone number to prospective users. When they received an order, a courier (one of the boys from Xalisco) would drive to the location with balloons of black tar in his mouth and spit out the appropriate number, for example two balloons for $40. It was high quality heroin provided promptly and reliably. For white addicts, this was enticing. There was no need to go to a seedy neighbourhood and negotiate with addict sellers.

            The operators would check in with their clients to ensure service was satisfactory, calling to ask whether the courier was on time and provided the goods. If a client didn’t call for a few days, the operators might ring and ask if there was a problem. They would lower prices to build their clientele, and sometimes give out free samples to win favour.

            If police pulled over a courier, he would swallow the balloons. Initially, police sent couriers back to Mexico. They were replaced within days. Later, some courts sent couriers to jail with long sentences. They were replaced too, with little interruption to business. Xalisco seemingly had a bottomless reservoir of poor young men willing to take chances to make money. Their reward was to impress their friends and families back home by taking them to expensive restaurants and building nice houses.

The Nayarit heroin operation happened to expand at just the time that opiate addiction was dramatically expanding due to sales of painkillers. For example, a high school football player might be injured and given OxyContin for the pain, developing an opiate habit. To maintain the habit, it was easy to switch to black tar, provided so conveniently.

The first major signal of this emerging opiate problem was deaths due to overdoses. A few individuals, in different parts of the US, started expressing concerns, but it was difficult to gain attention due to the pain revolution and the low profile of the black tar distribution operation. It was striking that the death were not blacks in big cities but whites in small towns. In many cases, parents did not know their children were addicted until they overdosed and died. The parents included politicians, doctors and judges. So why didn’t they speak out? The reason, according to Quinones, was shame. In white suburbs, heroin addiction was stigmatised as something happening somewhere else, to a different class of people. Many parents made up false stories about how their children had died. So it took a while before a few courageous parents started speaking out, raising the alarm.

Drugs and profit

In the US, there has been a so-called war on drugs since the 1930s, when federal authorities began a scare campaign about marijuana, whose use then was concentrated in immigrant communities. Illegal drugs were demonised. Meanwhile, legal recreational drugs, notably tobacco and alcohol, were massively advertised. Then came pharmaceutical drugs, also massively advertised.

            Drug issues are difficult to summarise briefly, especially because government pronouncements, media reports and advertising have cemented in certain attitudes. A simple contrast is between a policy of harm minimisation and one of regulated markets.

Markets are never “free,” but are shaped by government regulations, cultural expectations and social values. In the US, regulations enabled the profit motive to foster addiction and destroy communities.

The company selling legal opiates, Purdue Pharma, ended up making billions of dollars per year on the back of a massive marketing operation based on the claim that time-release opiate painkillers were hardly ever addictive. Profits drove the rapid expansion of use.

Making addictive drugs illegal is a different way to regulate a market. The trouble is that when the demand is inflexible, and alternatives are less enticing, this creates a strong incentive for organised crime. The result, often, is distribution via gangs, reliance on violence and corruption of the police and other authorities.

What is fascinating about the Xalisco distribution network is that it offers a different model for success in selling illegal goods: agents paid a salary rather than a commission, provision of high-quality service and goods, and avoidance of violence.

The US model for dealing with drugs has been disastrous for the people there and in the rest of the world. Tobacco is the world’s most damaging drug, and it was entrusted to large corporations with a huge incentive to expand sales. Alcohol is another damaging drug, again promoted heavily. Then there are pharmaceutical drugs, including morphine. Meanwhile, making some drugs illegal created different sorts of markets. The US war on drugs has contributed to corruption and the world’s highest imprisonment rate.

Quinones does not engage with arguments or efforts for law reform or a different way of managing drugs, instead simply telling the story of the different players in the US morphine/heroin saga. A compelling treatment of the US war on drugs is Johann Hari’s book Chasing the Scream.

In the US, there seems no end in sight for the toxic relationship with drugs. If ever there was a case for moving away from profit as a driving force, this is it.

There has been one good result. Overdose deaths in white middle-class areas have changed the attitudes of some politically conservative communities and politicians, creating more understanding and sympathy for opiate addicts. Perhaps there is some hope for change.


Sam Quinones

PS In recent months there has been some media coverage of opiate addiction problems in Australia.

Brian Martin
bmartin@uow.edu.au

When activists attack scientific dissent

Doing research on some topics can get you in trouble.


Alice Dreger

Alice Dreger was the ideal person to become an activist on issues of intersex and transgender. She was white and straight and hence could be a firm ally without being accused of self-interest or personal animus. She was an historian of science and able to research the issues as well as speak out about them. And she was articulate.

In the US in the past two decades, intersex and transgender have become hot topics. Dreger became involved, almost by accident, through a suggested PhD topic: the history of biomedicine and what, a century ago, was called hermaphroditism.

Intersex refers to people whose bodies do not conform to the conventional ideas of normal female or male. For example, some individuals have versions of both a penis and vagina. Others have an extra large clitoris. There are many variations. Dreger found that in many cases such individuals were brought up as one gender or the other and most people didn’t know the difference. But in some cases, doctors decided that babies with ambiguous genitalia needed to be “fixed” by surgery, for example their clitorises reduced in size. This sometimes caused physical damage and led to emotional problems.

From a human rights perspective, it can be argued that surgery for intersex should only be undertaken when a person can give informed consent. Even the assignment to one gender or another at birth needs to be undertaken with care.

After researching the history of medicine and intersex, Dreger obtained visibility on the issue, was contacted by activists and was drawn into campaigning for intersex rights. She voluntarily relinquished her tenured academic job to become an activist, and for a decade she used all her skills on behalf of those who were being harmed by the imposition of a medical-sexual orthodoxy on people’s bodies.

Scientific research and gender politics

By another set of accidents, Dreger entered an even more contentious domain: defending scientists who challenged conventional ideas about sexual identity. Michael Bailey argued that transgender is shaped by both biology and culture. He distinguished between two types of male-to-female transsexuals: “transkids” (Dreger’s preferred term) who are males attracted to other males, and “amour de soi en femme,” males who dream of being females. Only some change their bodily sex, depending on cultural conditions. Bailey drew on previous work by Ray Blanchard.


Michael Bailey

As well as publishing papers in scholarly journals, Bailey wrote a book, The man who would be queen, which received some publicity and also generated hostility from a few transgender campaigners who were offended by being characterised as “amour de soi en femme.” The hostility went beyond expressing disagreement. Bailey was targeted as a scholar and a person, for example with complaints made to his university about ethics violations.

Some people who knew Dreger urged her to look into the Bailey story. She did, using her skills as a researcher. She concluded that Bailey’s research work was solid. She also arranged to meet Bailey, to judge for herself claims that he was anti-gay and anti-trans. To her surprise, she discovered that he was totally comfortable with gay and trans people, and highly sympathetic to them.

Dreger wrote a long analysis of the Bailey saga and arranged for it to be published in an academic journal. It amounted to a defence of Bailey against his attackers.

“After nearly a year of research, I could come to only one conclusion: The whole thing was a sham. Bailey’s sworn enemies had used every clever trick in the book — juxtaposing events in misleading ways, ignoring contrary evidence, working the rhetoric, and using anonymity whenever convenient, to make it look as though virtually every trans woman represented in Bailey’s book had felt abused by him and had filed a charge.” (p. 100)

As a result, Dreger herself became a target. This experience set Dreger on a course of action: defending scholars who unfairly came under attack.

She tells of her experiences in an engaging book titled Galileo’s middle finger: heretics, activists, and the search for justice in science. It is a candid account of her personal trajectory, with extended treatments of several case studies, of which Bailey’s is one.

Dreger addresses the damaging potential of political correctness in sexuality studies and anthropology. Political correctness here refers to adherence to a particular viewpoint that is linked to fair treatment of disadvantaged groups, for example sexual minorities and indigenous groups. A classic example is the study of race and IQ. The politically correct view is that there are no systematic differences in innate intelligence between different ethnic groups, with measured IQ variations due to cultural factors. Anyone who studies race and IQ enters a treacherous terrain in which the “wrong” findings can lead to being attacked. Most researchers steer clear of such topics.

Dreger is critical of subordinating scientific research to belief systems. She believes that doing good research is vital, and those who do good research should be defended against ideologues. Furthermore, she made it a personal duty to become a defender in a number of cases.

The mirror side of this position is a concern about bad research used to bolster harmful practices. Dreger became alarmed about the use of a steroid during pregnancy that was supposed to reduce the risk that a child would be intersex. This drug was being dispensed by a senior scientist, Maria New, to numerous mothers. Dreger began investigating and concluded that the research justifying this intervention was thin and that mothers were not being properly warned that the drug was experimental.

In this case, Dreger became involved to promote good science by trying to expose what she believed was bad science. She thought the solution was to get government regulatory bodies – one of them was the Food and Drug Administration (FDA) – to examine the evidence, but to her dismay the FDA’s assessment was that all was okay. Dreger learned that regulators can sometimes give the stamp of approval to bad practice.

Suppression of dissent

Since the late 1970s, I have been researching what I call “suppression of dissent.” In a typical case, a scientist does research or speaks out on an issue and challenges the interests of a powerful group, and as a result comes under attack. In some fields, including forestry, nuclear power, pesticides, fluoridation and vaccination, there is a pattern of suppression, with numerous scientists, engineers, doctors, dentists and others being penalised for expressing their views.

In some of these areas, there are key works describing numerous cases of suppression of dissent. George Waldbott, a US doctor critical of fluoridation, documented many cases of suppression of fluoridation critics in his 1965 book A struggle with titans. Robert van den Bosch, a US scientist, recounted case after case of reprisals against scientists who questioned the orthodoxy on pesticides in his 1978 book The pesticide conspiracy. David L. Lewis, yet another US scientist, tells of numerous suppression cases in his 2014 book Science for sale. To this list must now be added Dreger’s book Galileo’s middle finger.

(Suppression doesn’t only occur in the US! The 1986 edited book Intellectual suppression reports on numerous Australian cases and gives references to cases in other countries.)

There are many similarities between Dreger’s approach to suppression of dissent and my own experience. Both of us address challenges to scientific orthodoxy, often linked to influential groups, and attacks against dissidents. Each of us, in addition, became involved in a critique of establishment figures. In my case this involved analysis of the pro-nuclear positions of Sir Ernest Titterton and Sir Philip Baxter.

There are also some differences between our experiences and approaches. Most obviously, Dreger has addressed identity issues and taboo topics and encountered hostility from a particular group of activists. This is a different sort of configuration than the patterns I’ve mainly looked at, which involve vested interests of industry or government groups.

Another difference is that Dreger investigates research and researchers in considerable depth in order to determine who is right, scientifically. If, by her assessment, a scientist is doing good research, indeed better research than others, then it is unfair for the scientist to come under attack. This is a sound approach.

My usual approach is somewhat different. I do not seek to determine who is right, scientifically, for example whether a researcher’s findings on pesticides or vaccination are superior to others. My concern is that researchers should not be penalised just because their findings challenge orthodoxy or threaten vested interests. For this, the double standard test is useful. If two scientists do research on pesticides or vaccination, and one reaches conclusions supporting the orthodox view and one reaches conclusions challenging it, are they treated the same way? If the dissent-supporting scientist suffers reprisals but the orthodoxy-supporting scientist does not, this suggests suppression of dissent.

Galileo’s middle finger is an important book. Dreger learned from her journey:

“how badly most people want simple stories of male and female, nature and nurture, good and evil; how the Internet has gutted the Fourth Estate; how the government is made up of fallible and occasionally disappointing humans; and why, more than ever before, democracies must aggressively protect good research.” (p. 189)

Dreger has forged a vital path in a highly contentious area, and told of her experiences in a revealing and perceptive way. Anyone interested in science in a free society should pay heed.

Brian Martin
bmartin@uow.edu.au

Thanks to Anneleis Humphries, Michael Matteson, Ben Morris and Tracey Woolrych for helpful comments.

Stress: how it can be good for you

By changing the way you think, you can deal with stress more effectively and use it to serve your goals.

A friend complains about being stressed: there’s a deadline at work, one of the kids is sick, the car broke down and she had a nasty argument with a neighbour. Stressful indeed. So the usual goal is to reduce stress, to avoid it. This seems like common sense.

However, when it comes to physical activity, the idea of reducing stress has long been discredited. Exercise is good for you, as long as it’s not too much. For athletes, training is designed to provide the amount of stress on muscles to build them up without causing injury.

Lack of physical stress is disastrous for the body. Lying in bed for day after day is a health hazard, with muscle wastage and other adverse consequences.

If the body needs optimal stress for best performance, what about the mind? Are there actually advantages to stress? The answer to these questions, according to Kelly McGonigal, is an emphatic yes, as indicated by the title of her book The upside of stress: why stress is good for you (and how to get good at it).

McGonigal spent many years recommending the usual advice to reduce stress. Then she was stimulated to rethink her position and started looking into research on the benefits of stress.

McGonigal writes in an engaging fashion. She draws on her personal experience and tells about research findings in an accessible way, often providing stories about the researchers or about people who have been changed by adopting a different approach to stress.

Think differently

Here’s the most amazing finding. If you think that stress is good for you, it will actually become better for you.

McGonigal cites research by Alia Crum. In one of Crum’s studies, one group of hotel housekeepers was told that the physical work they did on the job was a form of exercise and good for them; the other group was told only that physical exercise was good for health. Then after a period of four weeks, each group’s physiological parameters were measured. The group that thought of work as exercise did better, including losing weight and body fat and reducing blood pressure. Simply thinking about their work differently changed its effect on their bodies.

Another typical experiment goes like this. Two groups of subjects are prepared for a stressful experience, for example giving a talk in front of a large audience. One group is given the usual advice that stress is not good for you and that they should to try to relax. The other group is told that stress is a useful tool. The group thinking positively about stress performs better according to independent judges.

Then there are physiological tests. One group, put into a stressful situation, is told in advance that they’ll feel nervous and should try to relax. The other group is told they’ll feel excited. The group that interprets stress as excitement actually has lower levels of biomarkers for harmful products.

The implication is that fearing and avoiding stress causes harm, whereas accepting and embracing stress can reduce its negative impacts and enable better performance.

Mindsets

These results reflect an important process: the influence of thinking on behaviour, in particular the role of a mindset, which is a framework for understanding the world, or oneself. Carol Dweck in her book Mindset described two ways of thinking about intelligence and performance. One is the fixed mindset, in which an individual sees performance as reflecting an innate capacity. The other is the growth mindset, in which performance is seen as reflecting effort. The growth mindset is far better for long-term improvement. People with a fixed mindset avoid challenges where they might fail, because failure might shake their belief about themselves, whereas people with a growth mindset see failure as indicating they need to work harder.

Mindsets about stress are similarly important. The key thing is that they affect behaviour in systematic ways. Believing stress is bad leads to efforts at distraction, getting rid of feelings (rather than addressing their source), drug use and withdrawal. In contrast, when people believe stress is beneficial, they accept the existence of stressful events, strategise, seek information and advice, address the source of stress and make the best of the situation.

Stress responses

McGonigal traces negative attitudes to stress to Hans Selye’s classic studies of the effects of stress on rats. They were highly traumatised, and these findings were interpreted by doctors and the public as indicating that stress should be avoided. This was not Selye’s intention, because there were important differences between the experiences of his rats and those of most people. Selye’s rats were exposed to electric shocks in a situation in which the shocks were unpredictable, unavoidable and meaningless. In contrast, the stresses that most people experience in their daily lives are fairly predictable, sometimes avoidable and often quite meaningful.

“Even in circumstances of great suffering, human beings have a natural capacity to find hope, exert choice, and make meaning. This is why in our own lives, the most common effects of stress include strength, growth, and resilience.” (p. 45)

One of the ways to benefit from stress is to recognise that it provides the resources to deal with situations. Stress commonly causes your heart rate to increase, your body to sweat and your attention to become focused. The trick is to realise that these responses are helpful for dealing with challenges: your attention is focused on the issue at hand, your senses are heightened, your energy is mobilised. So rather than trying to dampen the stress response by avoidance, it can be used to take action.

A second dimension of the stress response relates to interactions with others. To benefit from stress, the key is to get beyond the fight-or-flight options and instead adopt a “tend and befriend” response. This means to interact with others, to help others, to be sensitive to others’ emotions, and to defend them.

There is a third dimension to the stress response: it can help you learn and grow. The way your body responds to stress can help integrate experiences.

The first half of McGonigal’s book is about understanding stress, covering these three dimensions. The second half is about transforming stress, addressing the same three dimensions, describing ways to learn how to change stress from a negative to a positive. This involves exercises to use anxiety (a stress response) for achieving goals, to respond to stress by caring for others and thus build resilience, and to become stronger as a result of stress.

This last dimension can seem unfair. If you’re subject to traumatic experiences, why should the onus be on you to use this as a way of becoming stronger? McGonigal repeatedly emphasises that trauma is bad news: it has many downsides and should be avoided. But trauma is an inevitable part of most people’s lives, and it is worth knowing that it is possible to gain something from it. This is a matter of recognising the hardship involved but also trying to gain something from the experience.

Making attacks backfire

Over the past twenty years, I’ve heard from hundreds of individuals who are concerned about being sued for defamation. Some are worried that something they have said would open them to legal action. Others have received letters from lawyers demanding an apology and a payment for damages. A few have received a writ and are facing expensive court proceedings.

Many of them are frightened, even terrified. They are afraid they might be sued and end up losing their house. To say they are stressed is to put it mildly. They often don’t know what to do and, while looking for information, have stumbled across my website.

McGonigal’s approach to stress offers a different way of thinking about legal threats. Rather than fearing them, they sometimes can actually be welcomed because of the opportunity to try to make them counterproductive for the perpetrators. Truda Gray and I have written about how to use publicity and other means to make defamation threats and actions backfire.

In some cases, there is no easy option, but nonetheless there are options and they need to be carefully considered. The stress of being attacked can be used as a resource to generate courage, seek support and think strategically. Rather than cowering in fear, a better attitude is to think “Come and get me (and beware – you may regret it).”

More on mindsets

In some ways, McGonigal’s biggest challenge is people’s deep-seated beliefs that stress is bad. She is fighting an uphill battle, and experimental findings and stories will only go so far. What is really required is a change of mindset, to rethink stress and how to respond to it.


Kelly McGonigal

McGonigal reports quite a few studies of “mindset interventions.” These are typically group sessions lasting 30 minutes to a few hours designed to change the way people think about themselves and the world. Done well, a mindset intervention can lead to lasting changes in behaviour, for example improved academic performance.

This can be hard to believe. Teachers spend hundreds of hours with students trying to help them learn, and can react with scepticism to someone who says a short session can make a lasting difference. There’s another confounding factor: people whose mindsets are transformed don’t even remember the intervention. They think of things differently and do better because that is their new reality. No extra effort is needed.

If you want to change the way you react to stress, you can create your own personal mindset intervention. Get The Upside of Stress and read some of it. Then write down a brief account of how you could react to stress more positively. Then tell someone else about what you’ve read and how they could change their own reactions. That’s it. It’s not much, and can have lasting benefits.

Brian Martin
bmartin@uow.edu.au

Thanks to Dalilah Reuben-Shemia for useful comments.